Geriatric Mental Health Disaster and Emergency Preparedness

Chapter 16 The Experience of Vulnerability in Geriatric Combat Veterans 339
in the context of the veteran’s social and familial functioning and incorporates
psychodynamic group process. Films are used as catalysts for discussion.
This has met with a good degree of success with Korean and WWII
populations. Movie therapy involves viewing videos followed by discussion
during two to three counseling sessions. The movies are selected to challenge
the limitations and prejudices of the defense mechanism of avoidance
of beliefs about self, others, and the world. The discussions allow
the veteran to use the objective narrative of the video to project an aspect
of his or her own questions and unresolved material. Such discussions
have resulted in increased insight, reduced avoidance, and a reduction in
anxiety. There has been a noticeable enhancement of feelings of selfconfidence
and cognitions/beliefs about safety and trust with regard to the
past that are more adaptive, constructive, and realistic. Other psychosocial
rehabilitation activities include (1) education about various resources
and concrete services available to this population within the VA and the
larger community, (2) enhanced social interaction through the use of social
activities outside the VA, (3) the support and assistance of veteranled
initiatives related to care for troops and the wounded, and (4) monthly
multifamily support groups.
SUMMARY
Presently, there is a very sparse body of literature that discusses the use
of EBP, specifically CBT, with the geriatric veteran population. With the
trend in the VA to make CBT available to all veterans who either request it
or are assessed as potential candidates for this therapy, it is likely that the
body of research literature on this population will expand. As discussed
earlier, asking basic questions of older combat veterans with chronic and
severe PTSD suggests that while some of our therapeutic efforts have been
helpful, the overall outcome has not produced an appreciable reduction
in symptom expression for this population. Given the therapeutic success
with younger veterans, it is expected that CBT would result in a reduction
in symptoms in the older veteran population with chronic and severe PTSD.
The philosophy and protocols of this type of intervention may help the
older veteran understand his or her reactions to the threat of global and local
terrorism, war, and biochemical attacks. In this process, perhaps the
older veteran will discover his or her inner strength and resources hidden
by fear. It is worth repeating that CBT requires extensive therapist training.
Untrained professionals or paraprofessionals should not utilize CBT.